STEUBENVILLE, Ohio - Local oncologists are fuming over the release of recommendations that would lead to fewer mammographies for women over the age of 40 if the medical profession were to adopt them. Oncologists at the Tony Teramana Cancer Center say mammograms must continue to be recommended for women over age 40.
The doctors at the cancer center at Trinity Medical Center West say they don't expect responsible physicians will take the recommendations from the U.S. Preventive Services Task Force to heart. The recommendations from the obscure government panel have come under fire this week for calling mammographies for women between age 40 and 50 as ineffective medicine that causes undue stress for false positive findings of cancer and recommend an end to the policy of advising annual mammograms for women over age 40 unless there are risk factors, though those are vague in the report.
Dr. Mark Trombetta, radiation oncologist and medical director of the center, and Dr. John Hyland, radiation oncologist, both noted Wednesday they were looking at cases of breast cancer in patients in their late 30s. Both physicians, who are based at the West Penn/Allegheny Health System in Pittsburgh, along with their colleagues at the Teramana Cancer Center, Drs. Pervaiz Rahman and Dennis Meisner, both oncologists from UPMC, termed the recommendations from the task force as "irresponsible."
ONCOLOGY AT WORK — Dr. Mark Trombetta, seated, and Dr. John Hyland, standing, radiation oncologists at the Tony Teramana Cancer Center, where Trombetta is medical director, look at test findings on a computer screen while working on a radiation plan with technician Melissa Hyndman at the cancer center. The doctors joined an outcry from front-line cancer fighters Wednesday against the changes to mammogram recommendations made by an obscure government panel. -- Paul Giannamore
"In 75 percent of the women, there are no risk factors," Trombetta said. "No competent and qualified oncologist will follow these guidelines."
Trombetta and Hyland said they suspected there's political motivation behind the finding, but said they expect the backlash will be such that the insurance industry won't be dictating changes in the current mammogram standards.
"The American Society of Breast Disease is unequovical, and most in the field are absolutely outraged by the recommendations," Trombetta said, noting there are no breast oncologists in the U.S. Preventive Services Task Force.
The White House backtracked on Wednesday, saying the task force has no power to deny health care coverage, and Republicans in Congress were calling the recommendations a preview of health rationing in a government health-care system.
In a letter to members, the American Society of Breast Disease said it continues to recommend annual mammograms for all women beginning at age 40, "based on long-standing, evidence-based studies which document that mammography saves lives through early detection."
The group said the fact that only 50 percent of American women over age 40 had a mammogram in the past year indicates more work needs to be done to encourage, rather than discourage, women from receiving the non-invasive test.
The society said there is 40 years of research with convincing evidence backing the benefits of mammography for screening for breast cancer.
"Long-term follow-up of randomized controlled population-based screening trials - the gold standard in medial research - prove that mammography can reduce breast cancer mortality as much as 32 percent among women ages 40 to 70 years at entry into screening," the group reported.
The breast disease society noted that screening only based on risk factors will miss cancers, with 70 percent of all women diagnosed with breast cancer having no known risk before diagnosis.
"The current flurry of media-hyped recommendations will only serve to confuse the public. To advise women age 40 and older to skip annual screening because they have no family history of the disease is imprudent, irresponsible and places their lives at unnecessary jeopardy," the society's letter concludes.
UPMC Cancer Centers and Magee-Women's Hospital in Pittsburgh also said regular mammograms for women age 40 and older must remain the standard.
"As a breast cancer community, we recognize that breast cancer screening and therapy are evolving, and we are committed to providing the best possible evidence-based care. This means that the mammogrpahic screening should be considered on an annual basis for women age 40 and older and the final decision about how to proceed should be made by the individual woman and her primary health care provider," the statement said.
The U.S. Preventive Services Task Force was convened by the U.S. Public Health Service in 1984 and has been sponsored since 1998 by the Agency for Healthcare Research and Quality. The 16-member federal task force claims to conduct "rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications," according to its Web site, www.uspreventiveservices.com.
(Giannamore can be contacted at firstname.lastname@example.org)